HomeMy WebLinkAboutChange of Sub/ sub agreement 13217337092 D.R.Horton—Melbourne 23:43:48 12-16-2015 2/9
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PLANNING &DEVELOPMENT SERVICES
- ..�r�. BUILDING& ZONING DIVISION ABC
tole 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 AUG 13 2021
(772) 462-1553 FAX 462-1578 St, .ti®le_Gourtty
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CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERNIT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work.There is a$50.00 fee for the Change of Contractor.
X CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 8/13/21 Permit Number: 21050455
Site Address: 9405 Potomac Dr
Ridgeway Plumbing State License CFC019077 SLC License 30947
Original GC,subcontractor or owner/builder
Mechanical One State License CFC1430061 SLC License 32493
New GC,subcontractor
Reason for Cancellation Vendor Change
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subcon 'ctor or gancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNA GENE O R orn as applicable)
PRINT NAME Brian Davidson PRINT NAME Jason James
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
13 day of AUGUST 20.21 ,by Brian Davidson 13 day ofAUGUST 2p by --i.mea
personally known who is personally known to me personally known who is personally known to
orwboh prod ce asID. meorylho-h sasp _duced— � �as1D.
8/13121 8/13/21
Signature of Notary Date Signature of Notary Date
ADINAPARRINO DINAPARRIND
, MY COMMISSION A GG 835649 LIF, „ MY COMMISSION q laG 835643
-91
.,
EXPIRES:FeEtuary 27,2024 ? EXPIRES;Fa6ruary 27,2024
Woded1hmNo1aryK&I1oUndenfd1tts ''f,!,?: 6andedTMu Notary Fwicundarmbra
13217337092 D.R.Horton—Melbourne 23:44:08 12-16-2015 3/9
PERMIT# 21050455 ISSUE DATE
�,_.. r,.... PLANNING&DEVELOPMENT SERVICES RECEIVED
Building & Code Compliance Division
6 AUG 13 2021
BUILDING PERMIT ab (31C4..�tftltll)r
SUB-CONTRACTOR AGREEMENT r�iittlrig
Mechanical One have agreed to be
(Company Name/Individual Name)
the Plumbing Sub-contractor for D.R.Horton Inc.
(Type of Trade) (Primary Contractor)
For the project located at 9405 Potomac Dr
(Project Street Address or Property Tax ID#)
It is understood that,if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St.Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATURE(Qualifier) SUB-CO TRACT I E 1' r)
Brian W. Davidson Jason James
PRINT NAME PRINT NAME
CRC1327068 CFC1430061
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of Brevard State of Florida,County of Brevard
The foregoing instrument was signed before me this_J3 day of The foregoing instrument was signed before me this 13 day of
August 202-1,by Brian W. Davidson August ,2021 by Jason James
who is personally known—Vor has produced a who is personally known V or has produced a
as identification, as identification.
STAMP ll STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Parrino
Print Name of Notary Public Print Name of Notary Public
lriir+u4c DINAPARRINO �jr•� •, DINAPARRINO
MY cOMMissioN#GG 93%43 .: 4.l MY COMMISSION It GG 935643
`•"�; 'a' EXPIRES:February 27,2024 ? a; EXPIRES:February27,2024
6ondedThruNotaryPubilcUndervrdUrs "`°', "�' 6ondW7hvNotayPub11eUndennil4r3